Content Warning: This section contains descriptions of mental illness, children in emotional distress, and discussions of mental illness inheritance.

The impact that mental illness has on the entire family of someone with mental illness is the primary theme explored throughout the novel, with the echoes of Mama’s irrational decision-making impacting nearly every moment of the novel. Della and Daddy both struggle to cope, reflecting how a family member’s illness can also affect their loved ones.  

Della is haunted both by the day-to-day impacts of Mama’s illness and her own sense of guilt: “I’d been the one who had made Mama the way she was. And I needed to be the one to fix it” (80). Della’s sense of misplaced responsibility for both causing Mama’s schizophrenia and feeling as though she needs to cure it develop the idea that familial mental illness can lead to misplaced feelings of self-blame and responsibility. Della also feels the need to cure Mama because she fears, more than anything, losing Mama to the mental hospital again. She “couldn’t bear the idea of turning thirteen next year and becoming a teenager without a healthy mama to guide her” (99). Della’s fears and fruitless efforts to fix Mama develop the idea that mental illness can create fear and uncertainty for families dealing with it.